A Prospective Quality Improvement Program to Reduce Prolonged Postoperative Antibiotic Prophylaxis in Ethiopia

Area of Science:

• Global Health
• Infectious Diseases
• Quality Improvement

Background:

• Prolonged postoperative antibiotic use is common in low- and middle-income countries, despite lacking evidence for preventing surgical site infections.
• Unnecessary antibiotic administration contributes to antimicrobial resistance and increases healthcare costs.

Purpose of the Study:

• To implement and assess a quality improvement program aimed at reducing prolonged postoperative antibiotic prophylaxis in a resource-constrained setting.
• To evaluate the impact of hospital-specific guidelines and multidisciplinary discussions on antibiotic prescribing practices.

Main Methods:

• A pilot program was conducted at a referral hospital in Ethiopia, involving adaptation of international guidelines to local contexts.
• A "timeout" during clinical rounds facilitated multidisciplinary discussions on antibiotic indication, choice, and duration.
• Data on antibiotic administration and patient length of stay were collected before and after intervention.

Main Results:

• The percentage of patients receiving ≥24 hours of antibiotic prophylaxis decreased from 50.9% to 40.9% (p = 0.027).
• The intervention was associated with a 0.5-day reduction in postoperative length of stay (p = 0.047).

Conclusions:

• The antibiotic stewardship program effectively reduced unnecessary postoperative antibiotic prophylaxis in a Sub-Saharan African hospital.
• The program demonstrates potential for decreasing antibiotic overuse and improving patient outcomes in resource-limited settings.